What is nicotine withdrawal?

Nicotine triggers the release of pleasure chemicals, including dopamine in the brain. The brain quickly becomes habituated to the nicotine effect and when it is removed, there are symptoms of discomfort which encourage further intake of nicotine to relieve those symptoms. Many of the so-called 'positive' effects of smoking are in reality caused by the reduction of nicotine withdrawal symptoms. The strength of the withdrawal symptoms alongside the strong habit formation around smoking, leads to a very strong addictive effect.

Data from NICE, 2024, What withdrawal symptoms is a person likely to experience when they stop smoking?

Symptom of withdrawal	How many affected	How long it lasts
Cravings for nicotine	70%	> 2 weeks
Appetite increase	70%	> 10 weeks
Restlessness	60%	< 4 weeks
Poor concentration	60%	< 2 weeks
Depression	60%	< 4 weeks
Irritability, anger, aggression	50%	< 4 weeks
Poor sleep	25%	< 1 week
Light headed	10%	< 48 hours

Why does smoking cause addiction?

Smoking addiction has a two fold mechanism including the physical effects of nicotine withdrawal symptoms which are relieved by the next smoke, and the strong habit formation often around social situations, the routine of lighting up and often sharing a smoke.

What is meant by cravings?

Cravings are powerful urges to smoke. As well as being triggered in the situations where you would normally have smoked, they can be triggered by stress, seeing other people smoking, or becoming intoxicated (alcohol or drugs).

How can I handle cravings?

Before quitting, make a list of your own potential triggers and trigger situations, and how you can avoid them. Have a plan and be prepared to deal with the cravings and temptation.

Suggestions include:

• Keeping busy.
• Playing a game on a mobile phone.
• Looking at the Smoke Free app or another 'support to quit' app.
• Drinking a glass of water.
• Changing the environment, for example going into another room or going outside.
• Taking some brisk exercise.

Try not to relieve cravings by eating or having a sweet/biscuit/chocolate. Stopping smoking itself can often increase your general appetite, which can lead to unhelpful weight gain.

It can also be helpful to concentrate on the benefits of stopping smoking, both to your general health and your bank account. Remember the amount of money you are saving. Some people find it helps to have a plan to save that money towards something new or a holiday.

What cancers are linked to smoking?

Tobacco smoke causes about 90% of all lung cancers and 1/5th of all UK cancer diagnoses each year. More than 16 different cancer types are linked to smoking, including cancer in the nose and sinuses, mouth, lips, tongue, throat, voice box (larynx), gullet (oesophagus), lung, bladder, kidney, liver, stomach, pancreas, leukaemia, bowel, ovary, and cervix. Over a quarter of UK cancer deaths are linked to smoking. Newer research also links smoking with Hodgkin's lymphoma, prostate cancer, and cancer in the womb, vagina, and vulva.

What other health risks are there from smoking?

Smoking has also been shown to be among the main causes of heart disease, strokes, and circulation problems including aortic aneurysms. One year after stopping smoking the risk of having a heart attack is reduced by a half.

Several studies link smoking to the development of most types of dementia, including Alzheimer's disease.

Apart from lung cancer, the lungs can also be damaged causing bronchitis, COPD (chronic obstructive pulmonary disease), and pneumonia.

Smoking can make other chronic diseases like diabetes, asthma, many skin conditions and multiple sclerosis worse. Other smoking related health risks (heart disease, strokes, aneurysms, dementia etc.) are even higher in people who smoke and suffer from other chronic diseases including alcoholism.

I've smoked for years - isn't it too late to stop now?

It is never too late to stop smoking. A man of 30 who gives up smoking will live on average 10 years longer than if he continued to smoke. Stopping at 40 years of age adds 9 years, at 50 it adds 6 years, and at 60 will add 3 years to life expectancy. It does not matter at what age smoking is stopped it will always improve the chances of a longer life.

Are there any health risks from e-cigarettes and vaping?

There have been some health concerns specific to e-cigarettes and vaping, due to the flavours, other additives and oil used in the vape liquid. Some additives including those causing so called 'popcorn lung' have been banned from UK vape fluids.

There are an increasing number of reports of young people who vape developing lipoid pneumonia, and lung damage due to inhalation of oils. As vaping and e-cigarettes are relatively new, further research is still needed to establish if there are long term health risks. Tobacco smoking had been established in the UK for 300 years before the serious health risks were proven!

Some e-cigarettes have been reported to explode or to catch fire.

How can I improve my chances of quitting smoking?

If you are mindful, notice your cravings, and find strategies to manage them that work for you, you are more likely to succeed in your quit smoking attempt. Here are some hints and tips for you to consider:

• Make a quit plan - think ahead about ways you will manage your cravings if and when they happen. Choose a quit date, stick to it, and seek support from family, friends, and colleagues.
• Know your triggers - cravings and thoughts about smoking can be triggered by the people you spend time with, the places you go, and the situations you encounter. Avoid your triggers, at least temporarily, after you quit to help lessen your cravings and give you time to build confidence and skills for remaining smoke free.
• Distract yourself - practice mindfulness and remember your reasons for quitting. Quitting smoking is great for your health, the health of those around you, and your bank account! Calculate how much money you will save per week / per year and what you could spend your money on instead.
• Get TXT message support - TXT the word CRAVE to 47848 to get 24/7 immediate support whenever you have a craving, or TXT QUIT to 47848 to sign up for SmokefreeTXT, a 6-8 week program of daily TXT message support, tips, and encouragement.
• Use the free Smokefree.gov app – track your cravings and understand your smoking patterns with one of the Smokefree.gov apps.

If you don't manage to quit 1st time, or if you relapse, then try again having learned from your previous experience. Further information: Managing Nicotine Withdrawal.

How is generic varenicline different to branded Champix?

Champix and generic varenicline tablets both have the same amount of active ingredient, varenicline, so will work in the same way. However, Champix was recalled and discontinued in the UK in October 2021 due to the presence of nitrosamines, an impurity, which were above acceptable levels. Generic varenicline is being manufactured by other companies now and has been approved by the MHRA for use and is nitrosamine compliant, with levels below the recommended acceptable intake limit. Consuming nitrosamines below this level has not been shown to increase the risk of cancer over a lifetime.

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